Provider Demographics
NPI:1033907415
Name:ROERICK, AMBER
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:ROERICK
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10111 MORRISON LINE RD
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:MN
Mailing Address - Zip Code:56331-9038
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4324 UNIVERSITY AVE STE B
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58203-1938
Practice Address - Country:US
Practice Address - Phone:701-746-4584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor